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Last Updated: 04/02/12

Meeting:

“Preoperative Therapy in Invasive Breast Cancer: Reviewing the State of the Science and Exploring New Research Directions”

March 26-27, 2007
Natcher Conference Center

Meeting description
Agenda with Video and Audio, Transcripts, and Presentation Slides
Flyer
Faculty list
Related Publications

MEETING DESCRIPTION:

Purpose: Preoperative therapy is increasingly being administered to women with breast cancer. Controversies exist, however, regarding optimal approaches.

This NCI-sponsored conference sought to determine the state of the science regarding clinical use of preoperative therapy in breast cancer, as well as identify future research agendas. Questions addressed by this meeting included the following:

  • What is established in the field of preoperative therapy for invasive breast cancer?

  • How should what is known be properly applied?

  • How should preoperative therapy be incorporated into research initiatives?

Leading breast cancer physicians presented the state of the science and engaged in a panel discussion in which audience participation was encouraged.

AGENDA:

DAY 1: MONDAY, MARCH 26, 2007
8:00 am to 6:00 pm

Welcome and introductions

Time Title
8:00-8:10 AM Welcome and purpose of conference
Eric Winer, M.D., Dana-Farber Cancer Institute
Julie Gralow, M.D., University of Washington School of Medicine

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8:10-8:25 AM Conference overview and importance of conference
James Doroshow, M.D., National Cancer Institute
Cokie Roberts, Senior News Analyst, NPR and ABC News

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Session I: Overview, and issues prior to breast cancer preoperative therapy

Moderators:
Jeffrey Abrams, M.D., National Cancer Institute
Laura Esserman, M.D., MBA, University of California, San Francisco

Time Title
8:25-8:40 AM Preoperative therapy - An overview
William Wood, M.D., Emory University School of Medicine
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8:40-8:55 AM Which patients are candidates for preoperative therapy, from a clinical (medical and surgical) perspective?
Which are the optimal candidates?

Gabriel N. Hortobagyi, M.D., F.A.C.P., M. D. Anderson Cancer Center
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8:55-9:10 AM Initial pathology assessment prior to preoperative therapy
Baljit Singh, M.B.B.S., M.D., New York University Medical Center
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9:10-9:30 AM Imaging the breast before preoperative therapy
Constance D. Lehman, M.D., Ph.D., University of Washington School of Medicine
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9:30-9:50 AM Evaluating the axilla and other nodal areas with non-invasive techniques
Nagi Khouri, M.D., Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center
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9:50-10:25 AM Pro's and con's of sentinel node biopsy pre- vs. post- preoperative therapy in operable disease

Pro-post-therapy: Terry Mamounas, M.D., MPH, Aultman Cancer Center
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Pro-pre-therapy: Jay Harris, M.D., Dana-Farber Cancer Institute/Brigham and Women's Hospital
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10:25-10:50 AM Question & Answer for Session I
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10:50-11:05 AM COFFEE BREAK

 

Session II: Systemic preoperative therapy for breast cancer

Moderators:
Nancy Davidson, M.D., Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center
Larry Norton, M.D., Memorial Sloan-Kettering Cancer Center

Time Title
11:05-11:30 AM NSABP Protocols B-18 and B-27: An update
Norman Wolmark, M.D., National Surgical Adjuvant Breast and Bowel Project (NSABP)
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11:30-11:55 AM Some relevant points of the European Experience in preoperative chemotherapy
Luca Gianni, M.D., Istituto Nazionale Tumori, Milan
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11:55 AM-12:15 PM Preoperative biologic therapy - anti-HER2 agents
Aman Buzdar, M.D., M. D. Anderson Cancer Center
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12:15-12:30 PM Preoperative biologic therapy - anti-angiogenic agents
Lisa Carey, M.D., University of North Carolina at Chapel Hill
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12:30-1:25 PM LUNCH BREAK
1:25-1:40 PM Preoperative treatment of the triple-negative (basal phenotype) breast cancer
Judy E. Garber, M.D., MPH, Dana-Farber Cancer Institute
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1:40-2:00 PM Preoperative hormonal therapy
Ian Smith, M.D., Royal Marsden Hospital, London
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2:00-2:25 PM Question & Answer for Session II
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Session III: Evaluating response to breast cancer preoperative therapy

Moderators:
Edith A. Perez, M.D., Mayo Clinic Jacksonville
George W. Sledge, Jr., M.D., Indiana University School of Medicine

Time Title
2:25-2:45 PM Breast imaging to monitor the response to therapy
Nola Hylton, Ph.D., University of California, San Francisco
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2:45-3:05 PM Pathologic assessment of the breast and axilla after preoperative therapy
W. Fraser Symmans, M.D., M. D. Anderson Cancer Center
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3:05-3:25 PM Appropriate endpoints in clinical trials and markers for long-term clinical outcome
Antonio C. Wolff, M.D., Johns Hopkins University, Sidney Kimmel Comprehensive Cancer Center
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3:25-3:40 PM COFFEE BREAK
3:40-4:00 PM When to consider mid-course changes of therapy based on early response?
Gunter von Minckwitz, M.D., Ph.D., German Breast Group
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4:00-4:20 PM Follow-up after preoperative therapy, including need for additional systemic therapy
Harold J. Burstein, M.D., Ph.D., Dana-Farber Cancer Institute/Harvard Medical School
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4:20-4:45 PM Question & Answer for Session III
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Session IV: Locally advanced and inflammatory breast cancer

Moderators:
Kathy S. Albain, M.D., Loyola University Chicago Stritch School of Medicine
Joseph Sparano, M.D., Albert Einstein Comprehensive Cancer Center

Time Title
4:45-5:00 PM Surgical perspective on locally advanced and inflammatory breast cancers
David Byrd, M.D., University of Washington School of Medicine
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5:00-5:15 PM Medical oncology perspective on locally advanced breast cancer
Stephen Chia, M.D. Vancouver Cancer Center
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5:15-5:35 PM Inflammatory breast cancer: A unique pathologic entity?
Sandra M. Swain, M.D., Washington Cancer Institute, Washington Hospital Center
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5:35-6:00 PM Question & Answer for Session IV
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DAY 2: TUESDAY, MARCH 27, 2007
8:00 am to 4:00 pm

Session V: Local-regional therapy after breast cancer preoperative therapy

Moderators:
Lisa Newman, M.D., MPH, University of Michigan Comprehensive Cancer Center
Timothy Whelan, BM, BCh, MSc, Juravinski Cancer Centre

Time Title
8:00 AM Opening of Day 2
Julie Gralow, M.D., University of Washington School of Medicine
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8:00-8:20 AM Indications for radiotherapy and selection of treatment fields after preoperative therapy
Thomas Buchholz, M.D., M. D. Anderson Cancer Center
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8:20-8:40 AM Surgical issues after preoperative therapy
Barbara Pockaj, M.D., Mayo Clinic Arizona
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8:40-9:00 AM Reconstruction after preoperative therapy
Michael J. Miller, M.D., The Ohio State University
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9:00-9:25 AM Question & Answer for Session V
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Session VI: Preoperative therapy for breast cancer: Research issues

Moderators:
Clifford Hudis, M.D., Memorial Sloan-Kettering Cancer Center
Kathy Pritchard, M.D., Toronto-Sunnybrook Regional Cancer Centre

Time Title
9:25-9:45 AM Importance of obtaining preoperative research biopsies
Soonmyung Paik, M.D., NSABP Division of Pathology
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9:45-10:00 AM Proliferation and apoptosis as measures of response
Mitchell Dowsett, Ph.D., Royal Marsden Hospital, London
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10:00-10:15 AM Correlation between chemotherapy response and hormone receptor/HER1/2 expression
Marco Colleoni, M.D., European Institute of Oncology
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10:15-10:30 AM Molecular profiling
Lajos Pusztai, M.D., Ph.D., M. D. Anderson Cancer Center
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10:30-10:45 AM COFFEE BREAK
10:45-11:05 AM PET, MRI, and other imaging
David Mankoff, M.D., Ph.D., University of Washington School of Medicine
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11:05-11:25 AM "Window of opportunity" studies: Biologic opportunities and ethical issues
Matthew Ellis, M.B., Ph.D., Washington University in St. Louis School of Medicine
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11:25-11:45 AM Statistical considerations in preoperative trials
Donald Berry, Ph.D., M. D. Anderson Cancer Center
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11:45 AM-12:05 PM Ongoing and planned preoperative trials:
Considerations for further research

JoAnne Zujewski, M.D., National Cancer Institute
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12:05-12:20 PM Role of advocacy in preoperative trials
Mary Lou Smith, J.D., M.B.A., Research Advocacy Network
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12:20-12:50 PM Question & Answer for Session VI
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12:50-1:50 PM LUNCH BREAK

 

Session VII: Panel Discussion

Time Title
1:50-3:20 PM Panel discussion
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Moderators:
Gabriel N. Hortobagyi, M.D., F.A.C.P., Chair,
Department of Breast Medical Oncology,
M. D. Anderson Cancer Center

Cokie Roberts, Senior News Analyst,
NPR and ABC News

Panelists:
Harry D. Bear, M.D., Ph.D., Virginia Commonwealth University
Luca Gianni, M.D., Istituto Nazionale Tumori
Daniel F. Hayes, M.D., University of Michigan Comprehensive Cancer Center
Constance D. Lehman, M.D., Ph.D., University of Washington School of Medicine
Soonmyung Paik, M.D., NSABP Division of Pathology
Lori J. Pierce, M.D., University of Michigan Medical School
Andrea Richardson, M.D., Ph.D., Brigham and Women's Hospital
Barbara Smith, M.D., Ph.D., Massachusetts General Hospital

 

Session VIII: Concluding session

Time Title
3:20-4:00 PM Wrap-up "statement of the science"
Julie Gralow, M.D., University of Washington School of Medicine
Eric Winer, M.D., Dana-Farber Cancer Institute

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FACULTY LIST:

Speakers, Moderators, and Panelists

Jeffrey Abrams, M.D.
Chief, Clinical Investigations Branch
Cancer Therapy Evaluation Program
Division of Cancer Treatment and Diagnosis
National Cancer Institute

Kathy S. Albain, M.D.
Professor of Medicine
Loyola University Chicago Stritch School of Medicine
Director, Breast Clinical Research Program
Cardinal Bernardin Cancer Center

Harry D. Bear, M.D., Ph.D.
Lawrence Professor of Oncology
Chairman, Division of Surgical Oncology
Virginia Commonwealth University
Massey Cancer Center
Member, NSABP Foundation Board of Directors

Donald Berry, Ph.D.
Chair, Department of Biostatistics & Applied Mathematics
M. D. Anderson Cancer Center
University of Texas
Statistician, Breast Committee, Cancer and Leukemia Group B

Thomas Buchholz, M.D.*, ***
Professor, Radiation Oncology
M. D. Anderson Cancer Center
University of Texas

Harold J. Burstein, M.D., Ph.D.
Instructor, Department of Medicine
Harvard Medical School
Dana-Farber Cancer Institute

Aman Buzdar, M.D.*
Professor of Medicine, Department of Breast Medical Oncology
M. D. Anderson Cancer Center
University of Texas

David Byrd, M.D.
Professor, Department of Surgery
University of Washington School of Medicine

Lisa Carey, M.D.
Medical Director, University of North Carolina-Lineberger Comprehensive Cancer Center
University of North Carolina at Chapel Hill

Stephen Chia, M.D.*
Medical Oncologist
Vancouver Cancer Centre

Marco Colleoni, M.D.
Director, Research Unit in Medical Senology
Department of Medicine
European Institute of Oncology

Nancy Davidson, M.D.
Professor of Oncology
Breast Cancer Research Chair in Oncology
Sidney Kimmel Comprehensive Cancer Center
Joint Appointment in Biochemistry and Molecular Biology
The Johns Hopkins Bloomberg School of Public Health

James Doroshow, M.D.
Director, Division of Cancer Treatment and Diagnosis
National Cancer Institute

Mitchell Dowsett, Ph.D.
Head, Academic Department of Biochemistry
Royal Marsden Hospital, London

Matthew Ellis, M.B., Ph.D.
Associate Professor, Department of Medicine
Oncology Division
Washington University in St. Louis School of Medicine
Vice-Chair, Breast Committee, Cancer and Leukemia Group B

Laura Esserman, M.D., MBA
Professor, Surgery and Radiology
Director, Carol Franc Buck Breast Care Center
UCSF Comprehensive Cancer Center
University of California, San Francisco

Judy E. Garber, M.D., MPH
Director, Cancer Risk and Prevention Program
Associate Professor of Medicine, Harvard Medical School
Dana-Farber Cancer Institute

Luca Gianni, M.D.
Director, Division of Medical Oncology
Head, Clinical Pharmacology Laboratory
Istituto Nazionale Tumori, Milan

Julie Gralow, M.D.**, ***
Associate Professor, Medical Oncology
University of Washington School of Medicine and
Fred Hutchinson Cancer Research Center
Co-Chair, Breast Committee, Southwest Oncology Group

Jay Harris, M.D.
Chair, Department of Radiation Oncology
Dana-Farber Cancer Institute/
Brigham and Women's Hospital
Professor of Radiation Oncology
Harvard Medical School

Daniel F. Hayes, M.D.
Clinical Director, Breast Oncology Program
University of Michigan Comprehensive Cancer Center

Gabriel N. Hortobagyi, M.D., F.A.C.P.
Chair, Department of Breast Medical Oncology
M. D. Anderson Cancer Center
University of Texas

Clifford Hudis, M.D.
Chief, Breast Cancer Medicine Service, Memorial Sloan-Kettering Cancer Center
Co-Chair, Breast Committee, Cancer and Leukemia Group B

Nola Hylton, Ph.D.
Director, Magnetic Resonance Science Center
University of California, San Francisco

Nagi Khouri, M.D.
Director of Breast Imaging
Johns Hopkins University Sidney Kimmel Comprehensive Cancer Center

Constance D. Lehman, M.D., Ph.D.
Associate Professor, Radiology, University of Washington School of Medicine
Director of Breast Imaging, Seattle Cancer Care Alliance

Terry Mamounas, M.D., MPH*, ***
Medical Director
Aultman Cancer Center
Chair, Breast Committee, National Surgical Adjuvant Breast and Bowel Project

David Mankoff, M.D., Ph.D.*, ***
Professor, Radiology Department
University of Washington School of Medicine

Michael J. Miller, M.D.
Professor of Surgery
Chief, Division of Plastic Surgery
The Ohio State University

Lisa Newman, M.D., MPH
Medical Director, Breast Cancer Center
Associate Professor, Surgery
University of Michigan Comprehensive Cancer Center

Larry Norton, M.D.
Deputy Physician-in-Chief for Breast Cancer Programs
Norna S. Sarofim Chair in Clinical Oncology
Memorial Sloan-Kettering Cancer Center

Soonmyung Paik, M.D.
Director, Division of Pathology
National Surgical Adjuvant Breast and Bowel Project

Edith A. Perez, M.D.
Professor of Medicine
Director, Clinical Investigations
Director, Breast Cancer Program
Division of Hematology/Oncology
Mayo Clinic Jacksonville
Chair, Breast Committee, North Central Cancer Treatment Group

Lori J. Pierce, M.D.
Professor, Department of Radiation Oncology
University of Michigan Medical School

Barbara Pockaj, M.D.*
Associate Professor of Surgery
Mayo Clinic Arizona

Kathy Pritchard, M.D.
Professor of Medicine, University of Toronto
Chair, Breast Cancer Site Group, Toronto-Sunnybrook Regional Cancer Centre
Co-Chair, Breast Site Group, National Cancer Institute of Canada Clinical Trials Group

Lajos Pusztai, M.D., Ph.D.
Associate Professor, Breast Medical Oncology
M. D. Anderson Cancer Center
University of Texas

Andrea Richardson M.D. Ph.D.
Instructor, Department of Pathology, Harvard Medical School
Associate Physician, Surgical Pathology, Brigham and Women's Hospital

Cokie Roberts
Senior News Analyst, NPR and ABC News

Baljit Singh, M.B.B.S., M.D.
Associate Professor, Department of Pathology
New York University Medical Center

George W. Sledge, Jr., M.D.
Professor of Medicine, Hematology/Oncology
Indiana University School of Medicine
Chair, Breast Committee, Eastern Cooperative Oncology Group

Barbara L. Smith, M.D., Ph.D.
Surgical Oncologist
Co-Director, Gillette Center for Women’s Cancers
Massachusetts General Hospital

Ian Smith, M.D.
Professor of Cancer Medicine, Department of Medicine
Head of Breast Unit
Royal Marsden Hospital, London

Mary Lou Smith, J.D., M.B.A.
Co-Founder
Research Advocacy Network

Joseph Sparano, M.D.
Professor of Medicine, Albert Einstein College of Medicine
Director, Breast Evaluation Center
Director, Clinical Trials Office
Albert Einstein Comprehensive Cancer Center
Montefiore Medical Center
Vice-Chair, Breast Committee, Eastern Cooperative Oncology Group

Sandra M. Swain, M.D.*
Medical Director
Washington Cancer Institute
Washington Hospital Center

W. Fraser Symmans, M.D.*
Associate Professor of Pathology
M. D. Anderson Cancer Center
University of Texas

Gunter von Minckwitz, M.D., Ph.D.
Board of Directors, Breast International Group
Principal Investigator, German Breast Group

Timothy Whelan, BM, BCh, MSc
Radiation Oncologist
Professor, Department of Medicine, McMaster University
Director, Supportive Cancer Care Research Unit, Juravinski Cancer Centre
Co-Chair, Breast Site Group, National Cancer Institute of Canada Clinical Trials Group

Eric Winer, M.D.**, ***
Director, Breast Oncology Center
Dana-Farber Cancer Institute
Associate Professor of Medicine
Harvard Medical School
Co-Chair, Breast Committee, Cancer and Leukemia Group B

Antonio C. Wolff, M.D.*, ***
Associate Professor of Oncology
Johns Hopkins University
The Sidney Kimmel Comprehensive Cancer Center

Norman Wolmark, M.D.
Chairman, National Surgical Adjuvant Breast and Bowel Project
Professor and Chairman of Human Oncology, Drexel University School of Medicine
Chairman, Department of Human Oncology, Allegheny General Hospital

William Wood, M.D.
Joseph Brown Whitehead Professor and Chairman, Department of Surgery
Emory University School of Medicine
Chair, The Breast Cancer Intergroup of North America

JoAnne Zujewski, M.D. **, ***
Head, Breast Cancer Therapeutics
Clinical Investigations Branch
Cancer Therapy Evaluation Program
Division of Cancer Treatment and Diagnosis
National Cancer Institute

*Planning Committee
**Co-Chair, Planning Committee
*** Writing committee

Also on Planning Committee:

Sandra Batte
Patient Advocate
The Susan G. Komen Foundation

Rose Mary Padberg, R.N., M.A.
Branch Chief, Cancer Education
National Cancer Institute

Rebecca Enos, MPH
NCI Contractor

Related Publications

Locally advanced and inflammatory breast cancer
Chia S, Swain SM, Byrd DR, Mankoff DA.
J Clin Oncol. 2008 Feb 10;26(5):786-90.

Preoperative chemotherapy: updates of National Surgical Adjuvant Breast and Bowel Project Protocols B-18 and B-27
Rastogi P, Anderson SJ, Bear HD, Geyer CE, Kahlenberg MS, Robidoux A, Margolese RG, Hoehn JL, Vogel VG, Dakhil SR, Tamkus D, King KM, Pajon ER, Wright MJ, Robert J, Paik S, Mamounas EP, Wolmark N.
J Clin Oncol. 2008 Feb 10;26(5):778-85.

Preoperative therapy in invasive breast cancer: pathologic assessment and systemic therapy issues in operable disease
Gralow JR, Burstein HJ, Wood W, Hortobagyi GN, Gianni L, von Minckwitz G, Buzdar AU, Smith IE, Symmans WF, Singh B, Winer EP.
J Clin Oncol. 2008 Feb 10;26(5):814-9.

Research issues affecting preoperative systemic therapy for operable breast cancer
Wolff AC, Berry D, Carey LA, Colleoni M, Dowsett M, Ellis M, Garber JE, Mankoff D, Paik S, Pusztai L, Smith ML, Zujewski J.
J Clin Oncol. 2008 Feb 10;26(5):806-13.

Statement of the science concerning locoregional treatments after preoperative chemotherapy for breast cancer: a National Cancer Institute conference
Buchholz TA, Lehman CD, Harris JR, Pockaj BA, Khouri N, Hylton NF, Miller MJ, Whelan T, Pierce LJ, Esserman LJ, Newman LA, Smith BL, Bear HD, Mamounas EP.
J Clin Oncol. 2008 Feb 10;26(5):791-7.